Inspection·January 24, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents were free from abuse for 1 of 5 residents (Resident #1) reviewed for resident abuse. The facility failed to prevent Resident #1 from being physically abused by MA D who hit Resident #1 on the face during patient care on 11/10/2024. The noncompliance was identified as past noncompliance. The noncompliance began on 11/10/2024 and ended on 11/11/2024. The facility corrected the noncompliance before the survey began. This failure could place residents at risk of experiencing and enduring abuse causing a decreased quality of life. Findings included: Record review of Resident#1's face sheet dated 01/24/2025, reflected a [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted on [DATE]. Resident #1 had a diagnosis of Unspecified Dementia, Moderate, With Agitation (the loss of cognitive functioning, thinking, remembering, and reasoning, to such an extent that it interferes with a person's daily life and activities). Record review of Resident #1's quarterly MDS assessment, dated 06/26/2024, reflected a BIMS score of 1 out of 15, which indicated the severe cognitive impairment. Further review of Resident #1's MDS reflected the resident needed assistance with ADL care. The MDS did not indicate Resident #1 had a history behaviors experience of hallucinations, or the expression of false beliefs (delusions). Record review of Resident#1's, undated, comprehensive care plan reflected a focus area initiated on 11/08/2024, Resident #1 had impaired cognitive function or impaired thought processes related to diagnosis of Dementia. Interventions: Engage the resident in simple, structured activities that avoid overly demanding tasks. The resident had a history of trauma that may have a negative impact. The trauma is related to: a negative interaction with staff member. Goal: Maintain resident's safety and integrity during post trauma episode, using appropriate interventions. Intervention: If the resident has escalated, if possible do not touch the resident unless necessary for resident's or others safety. Two staff members while providing care. Date Initiated: 11/11/2025. Record review of the provider investigation report dated 11/10/2025 revealed MA D's written statement read in part At 2:23a.m, I heard someone yelling mama I went and checked all the rooms to see who (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 675922 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675922 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Manor Nursing and Rehabilitation 206 N Smith St Weimar, TX 78962 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)